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Significant reduction in blood product usage, same early outcomes: Blood conservation in infants undergoing open
Lyubomyr Bohuta1, Titus Chan2, Kevin Charette3
1Division of Cardiac Surgery, Seattle Children's Hospital, Seattle, Wash.
Insights
A blood conservation program significantly reduced donor blood product use in infants undergoing open-heart surgery. Early clinical outcomes remained unaffected, indicating a safe and effective strategy for pediatric cardiac surgery patients.
Area of Science:
- Pediatric Cardiac Surgery
- Transfusion Medicine
- Patient Blood Management
Background:
- Infants undergoing open-heart surgery often require donor blood products.
- Optimizing blood product usage is crucial for patient safety and resource management.
- Evaluating blood conservation strategies is essential for improving surgical outcomes.
Purpose of the Study:
- To assess the impact of a blood conservation program on donor blood product utilization.
- To evaluate early clinical outcomes in infants following open-heart surgery.
- To analyze trends in blood product transfusion over time.
Main Methods:
- Retrospective review of 409 infants (<1 year) undergoing open-heart surgery.
- Study divided into 4 eras: baseline (traditional management) and 3 eras of evolving blood conservation.
- Total blood product volume transfused per hospitalization was calculated and indexed to body weight.
Main Results:
- Median blood product volume decreased significantly from 128 mL/kg to 21 mL/kg across eras (P < .01).
- No significant differences observed in postoperative mechanical ventilation, ICU/hospital length of stay, or mortality (P > .05).
- Multivariate analysis confirmed reduced odds of blood product exposure in later eras.
Conclusions:
- Blood conservation significantly reduces blood product use in infant open-heart surgery without compromising early outcomes.
- This strategy is effective across various surgical complexity categories.
- Further research is needed to confirm long-term clinical impact.
Objective:
To evaluate the effect of a blood conservation program on trends in use of donor blood products and early clinical outcomes in infants undergoing open heart surgery.
Methods:
Four hundred nine patients younger than age 1 year undergoing open-heart surgery between October 1, 2020, and June 30, 2023, were reviewed. The study period was divided into 4 eras with the first era as a before blood conservation baseline using traditional blood management. The following 3 eras comprised incremental implementation and evolution of blood conservation strategies. The total volume of blood products transfused for each surgical hospitalization was calculated and indexed to body weight at time of surgery.
Results:
There was no significant difference in age at surgery, body weight, distribution of The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery categories, and in postoperative length of mechanical ventilation, intensive care unit or hospital length of stay, or postoperative mortality (P > .05 for all) across the 4 eras. Median total volume of blood products administered during hospitalization decreased from 128 mL/kg (range, 92-220 mL/kg) during the baseline period to 21 mL/kg (range, 6-44 mL/kg) during the last era (P < .01). Multivariate analysis demonstrated that later eras were associated with decreased odds of experiencing exposure to blood products during hospitalization.
Conclusions:
Blood conservation is associated with significant reduction in usage of blood products during open heart surgery in infants with no significant effect on early outcomes. This trend is observed across all categories of surgical complexity. Additional studies are needed to prove consistency and to determine the longer-term clinical impact of this strategy.
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